In this case the ovary appears to be slightly wandering upwards giving a confusing appearance to this lesion on the first look, as it can be seen in the lower abdomen rather than the pelvis and surrounded by small bowel loops. It is very important to identify the vascular supply of the lesion/ovary to confirm its nature and origin.
Ovarian dermoids (mature cystic teratoma) are benign lesions affecting young to middle aged women. They are usually asymptomatic, unless they grow to a large size, or in cases of torsion or rupture, then they can present by abdominal pain.
Pathologically they contain tissues from different germ cell origins (ectoderm, mesoderm and endoderm). Typically the presence of fat density and an osseous component (calcification) in a cystic ovarian lesion is enough to diagnose an ovarian dermoid with confidence. In this case, only the fatty content is evident on CT, still the differential diagnosis is very limited and an ovarian dermoid must be highly suggested.